ASSESSMENT OF CANCER PREVENTION SERVICES AT COMMUNITY MENTAL HEALTH CENTERS

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Administrator Interview	Form and Instruction	New	Available
Clinician Interview	Form and Instruction	New	Available
Administrator Survey Instrument	Form and Instruction	New	Available
Clinical Survey Instrument	Form and Instruction	New	Available
CMHC_OMB_SSB_080317.docx	Supporting Statement B	Uploaded 2018-02-27	Available
CMHC_OMB_SSA_02012018.docx	Supporting Statement A	Uploaded 2018-02-27	Available
CMHC_OMB_APPENDIX 2b_Summary of Comments.pdf	Supplementary Document	Uploaded 2018-02-27	Available
CMHC_OMB_SSA_APPENDIX 9_Clinician and Administrator Pilot Feedback Forms 080317.docx	Supplementary Document	Uploaded 2018-02-27	Available
CMHC_OMB_SSA_APPENDIX 8_Consent Materials 080317.docx	Supplementary Document	Uploaded 2018-02-27	Repair queued
CMHC_OMB_SSA_APPENDIX 7_Web Pages_080317.docx	Supplementary Document	Uploaded 2018-02-27	Available
CMHC_OMB_SSA_APPENDIX 6_Recruitment Materials_080317.docx	Supplementary Document	Uploaded 2018-02-27	Available
CMHC_OMB_SSA_APPENDIX 3_IRB Approval 080317.docx	Supplementary Document	Uploaded 2018-02-27	Available
60d FRN 82FR51837.pdf	Supplementary Document	Uploaded 2018-02-27	Available
CMHC_OMB_SSA_APPENDIX 1_Authorizing Legislation 080317.pdf	Supplementary Document	Uploaded 2018-02-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
230270	Administrator Interview	Form and Instruction	New
230269	Clinician Interview	Form and Instruction	New
230268	Administrator Survey Instrument	Form and Instruction	New
230267	Clinical Survey Instrument	Form and Instruction	New

ICR Details

OMB Control No: 0920-1229	ICR Reference No: 201802-0920-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17AZG
Title: ASSESSMENT OF CANCER PREVENTION SERVICES AT COMMUNITY MENTAL HEALTH CENTERS
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/11/2018
	Date Received in OIRA: 03/02/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	24 Months From Approved
Responses	1,100	0	0
Time Burden (Hours)	392	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: People with mental illness have increased risk behaviors for cancer such as smoking and lack of physical activity; however, they are less likely to receive cancer screening than persons without mental illness. Many people with mental illness receive outpatient mental health care at community mental health centers, some of which also offer screening for chronic conditions. This study will examine the capacities of community mental health centers to provide cancer prevention services, which is not well understood., and will assess barriers and facilitators to providing cancer prevention services at community mental health centers (CMHCS) in the United States. The study will conduct two surveys of psychiatric clinicians and administrators at selected facilities. Findings will be disseminated to target audiences such as National Comprehensive Cancer Control Program grantees and their state/local partners, other cancer prevention and control entities, and CMHC staff to help inform strategies that reduce cancer risk factors and improve cancer screening among persons with mental illness.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 51837	11/08/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 8874	03/01/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Administrator Survey Instrument	NA	National Survey on Community Mental Health Center Cancer Prevention Activities: Administrator Survey
Clinical Survey Instrument	NA	National Survey on Community Mental Health Center Cancer Prevention Activities: Clinician Survey
Clinician Interview	NA	Assessment of Cancer Prevention Services at Community Mental Health Centers: Interview Guide for Clinicians
Administrator Interview	NA	Assessment of Cancer Prevention Services at Community Mental Health Centers: Interview Guide for Administrators

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,100	0	0	1,100	0	0
Annual Time Burden (Hours)	392	0	0	392	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Submission of 0920-17AZG - ASSESSMENT OF CANCER PREVENTION SERVICES AT COMMUNITY MENTAL HEALTH CENTERS is a New Information Collection Request.

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Annual Cost to Federal Government: $284,336

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/02/2018

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